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- 저자 : ( Navindran Selvaraju ) (검색결과 1 건)
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Rare Case of Drug Induced Thrombocytopenia in a Challenging Pulmonary Tuberculosis Case
( Arvindran Alaga ),( Navindran Selvaraju ) 대한결핵 및 호흡기학회 2021 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.129 No.-
Introduction Thrombocytopenia in TB may occur owing to defective platelet production in the context of pancytopenia due to bone marrow infiltration, histiophagocytosis, thrombotic thrombocytopenic purpura, disseminated intravascular coagulation, immune mediated platelet destruction or as an adverse effect of therapy with rifampicin and isoniazid. We present to you a rare case of pyrazinamide induced thrombocytopenia. Case summary 34 year old male with body weight of 50kg with history of productive cough for 2 month presented with right sided pleuritic chest pain. Chest Xray revealed pneumothorax and chest tube was inserted. His FBC revealed Hb of 11.5g/dl, with WCC of 11 and platelet of 350 Inflammatory markers were raised with ESR of 80, with low albumin. He was then empirically started on T Akurit 4.TB GeneXpert and Line Probe Assay revealed M Tuberculosis complex After 73 days of treatment, we noted that platelet was gradually decreasing to 52.Decision was made to withhold Rifampicin. After 9 days of rifampicin cessation, platelet still continued to drop to 43 with sputum AFB of 2+ .Decided was made to off Isoniazid. He was then started on Ethambutol, Pyrazinimide and Levofloxacin (EZL) Despite withholding both drugs, platelet continued to drop 30. After 1 week of EZL regime, we stopped pyrazinamide, and restarted IV Streptomycin 750mg OD. Platelet then gradually increased to 84. He was then put on HREL regime for 18 days. Platelet continued to normalise to 160. Discussion Thrombocytopenia is an unusual complication of antitubecular medication. It is commonly associated with Rifampicin and to a lesser extend Isoniazid. Pyrazinamide associated thrombocytopenia are rare, therefore early detection of such causative drugs could lead to improved morbidity and outcomes.
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